Pediatric anesthesia pt3.2

Question 1

What is NEC?

Answer 1

Necrotizing enterocolitis (NEC): Intestinal inflammatory condition, typically occurs 2nd to bowel ischemia, bacterial invasion, and premature oral feeding

life threatening emergency

Question 2

What initial management should be done with NEC?

Answer 2

• ensure oxygenation
• Manage hypovolemia and acidosis
• NG decompression
• ABX

Question 3

What are common symptoms associated with NEC?

Answer 3

• Increased gastric residuals
• Abd distention
• bilious vomiting
• Fever

Question 4

What anesthetic considerations should be made with NEC?

Answer 4

• avoid N2O
• may need intropic support
• frequently septic
• Hydration/colloids

Question 5

Malrotation and midgut volvulus may generally present with what symptoms?

Answer 5

• Bilious vomiting
• tender/distended abd
• intestinal obstruction

high risk for aspiration

Question 6

When does malrotation become a volvulus?

Answer 6

When the intestine becomes twisted and ischemic

emergent procedure

Question 7

What anesthetic considerations should be made for malrotation and midgut volvulus?

Answer 7

• RSI/cricoid pressure
• Fluid/electrolyte replacement
• Sepsis tx
• CVL/A-line

Question 8

What can cause abdominal contents to protrude into the thoracic cavity and act as a space-occupying lesion?

Answer 8

Congenital Diaphragmatic hernia (CDH)

Question 9

What is a major concern from congenital diaphragmatic hernia (CDH)?

Answer 9

• can lead to poor lung development and respiratory issues

Question 10

What anesthetic considerations should be made with a congenital diaphragmatic hernia (CDH)?

Answer 10

• May need one-lung ventilation (OLV)
• Likely intubated already
• May only need opioids and NMB

Question 11

What pulmonary considerations should be made with anesthetic management of CDH?

Answer 11

• Permissive hypercarbia
• Avoid inflating stomach with air
• PIP should be kept <25-30 cmH2O
• Postop, keep PaO2 >150mmHg

Question 12

With CDH, increases in PVR should be avoided, what are some specific factors to control?

Answer 12

• Hypoxia
• Hypothermia
• Acidosis

Question 13

What are some prenatal symptoms and diagnostic signs for tracheoesophageal fistula and esophageal atresia?

Answer 13

Prenatal: polyhydramnios, stomach bubble on US
Diagnostic signs: cannot advance OGT, cough/choke after first feed, recurrent PNA with feeds

Question 14

What type of tracheoesophageal fistula and esophageal atresia is most common?

Answer 14

Type C most common

Question 15

What interventions can be done to reduce pulmonary complications from TEF and EA?

Answer 15

• Stop oral feedings
• Suction esophageal pouch
• Semi recumbent position (side lying)
• gastrostomy tube

Question 16

What anesthetic techniques would most likely be used for TEF and EA procedure?

Answer 16

• head up position
• Frequent suctioning
• Awake intubation
• Inhalational induction
• Maintenance of SV (avoid excess positive pressure)

Question 17

Why should PIP be minimized with a TEF and EA?

Answer 17

Positive pressure goes to the stomach from fistula

Question 18

If postoperative ventilation is needed after a TEF and EA procedure, the ETT should be placed ____ from the fistula repair, why?

Answer 18

If postoperative ventilation is needed after a TEF and EA procedure, the ETT should be placed 1 cm from the fistula repair to allow healing of suture line

Question 19

What is an imperforate anus? When is it typically diagnosed?

Answer 19

Disorder where the anal opening is missing or closed off.
Typically diagnosed when neonate doesn’t pass meconium within first few days of birth

ranges from mild stenosis to complete anal atresia

Question 20

In neonates with imperforate anus, what is the difference between male and female neonate treatment?

Answer 20

• Male neonate: urgent surgery to allow passage of meconium via colostomy
• Female neonate: sx can be delayed because of common presence of rectovaginal fistula (allows passage)

Question 21

Obstructed CSF flow within the brain is typical the cause of what? Why is this an issue?

Answer 21

Neonatal Hydrocephalus
-Leads to increased ICP

Question 22

What are signs of increased ICP, or hydrocephalus?

Answer 22

• Bulging anterior fontanelle
• Irritability
• Somnolence/LOC
• Vomiting
• CV collapse

Question 23

Neonates with hydrocephalus may need a ____ to drain excess CSF to the belly

Answer 23

Ventriculoperitoneal (VP) shunt

Question 24

Anesthesia management of neonatal hydrocephalus consists of what?

Answer 24

• control ICP
• RSI
• Extubate at end of procedure
• Keep in mind: inhalational agents can cerebral vasodilation at >1MAC which can lead to increased ICP
• May hyperventilate pt to decrease CO2 and cause cerebral vasoconstriction and decrease ICP

Question 25

Myelomeningocele is a form of ____? It is the most common CNS defect that occurs during the ____ month of gestation

Answer 25

Myelomeningocele is a form of **Spina bifida**. It is the most common CNS defect that occurs during the **1st** month of gestation

Question 26

Myelomeningocele is most often within the ____ region?

Answer 26

Myelomeningocele is most often within the **lumbosacral** region?

Question 27

Neonates with myelomeningocele may also have ____ which requires ____ placement

Answer 27

Neonates with myelomeningocele may also have **arnold-chiari malformation** which requires **VP shunt** placement

Question 28

Neonates with myelomeningocele's often have increased sensitivity to ____?

Answer 28

Latex

Question 29

Myelomeningocele neonates are prone to hypothermia, what can be done to mitigate this risk?

Answer 29

* warm OR * Heat lamps * air warmers * humified anesthetic gases * IVF warmer